During an assessment of a healthy adult, where would the nurse ...

[jace]

During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?
 
  a. Third left intercostal space at the midclavicular line
  b. Fourth left intercostal space at the sternal border
  c. Fourth left intercostal space at the anterior axillary line
  d. Fifth left intercostal space at the midclavicular line

Question 2

During the cardiac auscultation, the nurse hears a sound immediately occurring after the S2 at the second left intercostal space. To further assess this sound, what should the nurse do?
 
  a. Have the patient turn to the left side while the nurse listens with the bell of the stethoscope.
  b. Ask the patient to hold his or her breath while the nurse listens again.
  c. No further assessment is needed because the nurse knows this sound is an S3.
  d. Watch the patient's respirations while listening for the effect on the sound.

[ricroger]

Answer to Question 1

ANS: D
The apical impulse should occupy only one intercostal space, the fourth or fifth, and it should be at or medial to the midclavicular line.

Answer to Question 2

ANS: D
A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people. A split S2 is heard only in the pulmonic valve area, the second left interspace. When the split S2 is first heard, the nurse should not be tempted to ask the person to hold his or her breath so that the nurse can concentrate on the sounds. Breath holding will only equalize ejection times in the right and left sides of the heart and cause the split to go away. Rather, the nurse should concentrate on the split while watching the person's chest rise up and down with breathing.